1. Transfusion awareness
bloody
lesson!
Transfusion awareness
SPOTs

2. Transfusion awareness
Why do patients get transfused?
Red blood cells (RBC)
To treat symptomatic anaemia
To increase oxygen carrying capacity
To treat blood loss
Fresh Frozen Plasma (FFP)
To replace certain clotting factors during bleeds
Platelets (Plts)
To correct a low platelet count
To boost poorly functioning platelets
To combat bleeding/coagulation
Cryoprecipitate (Cryo)
To treat massive bleeds
To treat DIC
Transfusion awareness
SPOTs

3. Transfusion awareness
When to transfuse
Transfusion awareness
SPOTs

4. Transfusion awareness
When to transfuse
Always take samples from limbs that are not receiving any other type of infusion.
Blood samples taken from limbs receiving clear fluids will be diluted, rendering inaccurate results, this often leads to unnecessary/over transfusions (externally reportable to SHOT).
Always suspect and re-check spurious blood test results that don’t appear to match clinical symptoms prior to prescribing a blood transfusion.
Normal Hb = 140g/l – 180g/l (Men)
120g/l – 160g/l (Women)
Hb between ‘normal’ and 70g/dl should be investigated and treated but not necessarily with a blood transfusion.
Transfusion awareness
SPOTs

5. Transfusion awareness
Samples
Never pre-label sample bottles
Always have the request form available pre-bleed
Always identify your patient
Always label the sample before leaving the patient
Second samples
About 1 sample a month is sent through to Blood Bank which shows a different blood group to a sample previously tested for that patient!
(We know that wrong patients are being bled regularly – a potentially fatal mistake!)
2 samples must be taken on 2 different occasions ideally by 2 different people
(to guarantee the right patient has been bled = safety measure)
Do not take 2 samples at same time and use 2 different pens (we can tell!)
Do not take 2 samples at same time but put different times on bottles (defeats the object!)
Transfusion awareness
SPOTs

6. Transfusion awareness
How to prescribe blood
Considerations:
Could I use an alternative?
Can I justify this transfusion?
What should it be written up on?
What time is it?
Consent
Patient information
Transfusion awareness
SPOTs

7. Transfusion awareness
How to prescribe blood
Dosage:
Red blood cells = 1 bag
Platelets = 1 bag
Cryoprecipitate = 2 bags
FFP = 3 bags
Over how long:
Red blood cells = <3 hours
Platelets = <30 mins
Cryoprecipitate = <30 mins
FFP = <30 mins
Transfusion awareness
SPOTs

8. Transfusion awareness
Safe storage
Red blood cells (RBC):
Must only ever be kept in a blood fridge
An adult dose of RBC is one bag
Max out of fridge time = 4 hours
Must be returned within 30 minutes
Every bag of RBC thrown away costs you £150
Fresh Frozen Plasms (FFP):
Can be kept in a blood fridge or at room temperature
An adult dose of FFP is usually 3 bags
Max out of fridge time = 4 hours
Must be returned within 30 minutes
Every bag of FFP thrown away costs you £40
Platelets (Plts):
Must be stored agitated at room temperature
An adult dose of Plts is one bag
Max out off the agitator = 2 hours
Must be returned within 30 minutes
Every bag of Plts thrown away costs you £250
Cryoprecipitate (Cryo):
Must only be kept at room temperature once defrosted
An adult dose of Cryo is usually 2 bags
Max time from thawing = 4 hours
Must be returned within 30 minutes
Every bag of Cryo thrown away costs you £250
Transfusion awareness
SPOTs

9. Transfusion awareness
Pre-transfusion checks
Is the blood ready – how do I know?
Is the patient ready – is it prescribed?
are the obs ok?
route of administration?
is the patient going to be able to have it now?
what time is it?
Who is allowed to collect the blood?
Transfusion awareness
SPOTs

10. DOUBLE CHECK! Transfusion awareness SPOTs Blood Bank label:
A MISTAKE COULD KILL!!!!
Blood Bank label:
NHSBT label:
(Must check against info brought with you)
Full name
Date of birth
Hospital number
(All this info found by comparing these 2 labels)
Check donor numbers
Blood groups
Expiry date
Donor number
Must be exactly the same
Donor number
Transfusion awareness
SPOTs

11. Blood group compatibility
Red Blood Cells
Blood Group: A B AB O
Can have:
A or O
B or O
A, B, AB or O
Must not have:
B or AB
A or AB -
A, B or AB
Blood Group:
D-positive
D-negative
Can have:
D-positive or D-negative
Must not have: -
Platelets
Blood Group: A B AB O
First choice:
Second choice:
Third choice:
O (HT neg)
Fourth choice: -
O (HT neg) = High Titre Anti-A and Anti-B negative
FFP
Blood Group: A B AB O
Can have:
A, B, AB
O, A, B, AB
Must not have: -
Cryoprecipitate - does not need to be ABO or Rh D matched.
Transfusion awareness
SPOTs

12. Blood group compatibility
The most compatible blood group to give to your patient is exactly the same group that they are (this includes O-ve too!)
If Blood Bank issues blood that is not the same group as your patient it must display this sticker
ATTENTION
THERE IS A DIFFERENCE BETWEEN THE DONOR
AND THE RECIPIENTS BLOOD GROUP. HOWEVER
THIS UNIT IS SUITABLE TO TRANSFUSE
If you do not see this sticker and you have been given a different blood group do not transfuse it – ring Blood Bank for clarification.
Transfusion awareness
SPOTs

13. Transfusion awareness
Tracing where the blood has gone
Legally we must be able to track all units of blood and prove which blood has been given to which patient and which units were wasted
It is no longer acceptable to just write ‘blood’ in the patients notes – the donation number must be recorded (use the stickers off the bags)
In emergency situations this information can be entered retrospectively
Even the emergency O-ve has to be traced! ?
Transfusion awareness
SPOTs

14. Transfusion awareness
The blood prescription chart
Blood must be written up on an STH blood prescription chart
Time of collection should be filled in by the person who collected it
Should lead you step by step through the bedside checking and administration process
Each chart has enough room for 6 bags of blood
Transfusion awareness
SPOTs

15. Transfusion awareness
The bedside check
Two people must check ALL blood components at the side of the patient prior to putting it up for transfusion (not at the nurses desk!!!)
These two people must be assessed as competent:
Mistaeks
Happen
Person 1:
A qualified nurse
A qualified midwife
A qualified ODP
A qualified doctor
Person 2:
A qualified nurse
A qualified midwife
A qualified ODP
A qualified doctor
Transfusion awareness
SPOTs

16. Transfusion awareness
Giving set lines
Type of giving set: Blood must only ever be given through a blood giving set (integral filter) and for every different type of blood – use a different blood giving set
Changing lines: Manufacturer’s instructions state a blood giving set should be changed after every 2nd unit of blood transfused
Priming lines: It is not necessary to prime a giving set with anything other than the blood (only 0.9% sodium Chloride is compatible with blood)
Volumetric pumps: Where possible/when appropriate it is preferable for blood to be given via a volumetric pump
Flushing lines: On completion of the transfusion, do not flush the blood giving set (don’t transfuse the contents of the filter).
Type of giving set:
Changing lines:
Priming lines:
Volumetric pumps:
Flushing lines:
Transfusion awareness
SPOTs

17. Transfusion awareness
Minimum observations
Blood observations must be clearly identifiable, and must be retained with the transfusion episode as part of the notes which must be kept for 30 years.
Observations must be recorded electronically or on the observation chart & prescription chart
(Minimum obs)
Pre-transfusion: at least minutes before the transfusion a full set of SHEWS and temperature must be recorded
15 minutes after starting each unit of blood (not just red cells): another full set of SHEWS and temperature must be recorded
Hourly: (If the patient is ok) a temperature and pulse must be recorded.
On completion: a full set of SHEWS and temperature must be recorded
Transfusion awareness
SPOTs

18. Transfusion awareness
Reaction management
If a transfusion reaction is suspected you must immediately stop the transfusion
Contact doctor and nurses in charge
Re-check that the right bag of blood was put up for the right patient
Record observations every 15 minutes until episode subsides
If the blood is to come down – send it back to Blood Bank for investigation along with a suspected transfusion reaction form (download from the intranet) fresh samples will . also be required
Document what has happened and what has been done about it – it will need reporting as an incident as it will go to the Serious Hazards of Transfusion!
Transfusion awareness
SPOTs

19. Transfusion awareness
SPOTs

20. Transfusion awareness
For more information
SPOT - Jill Rowlands ( )15246
(There will be a Transfusion Practitioner where you work – Jill can put you in touch)
Lead Transfusion Consultant
Hospital Transfusion Team
Hospital Transfusion Committee
Hospital Intranet Site
Local Blood Transfusion Policy
Transfusion awareness
SPOTs